Many people dream of one day having children but for some, this can prove to be a difficult and emotional journey. According to recent research, one in eight women and one in ten men in the UK have experienced infertility, struggling to get pregnant for at least a year.1 According to the National Institute for Health and Care Excellence (NICE) up to 45% infertility results from ovulatory disorders and 30% from male reproductive issues.2 For people hoping to one day raise a child and family, infertility can seem a cruel and heartbreaking blow to the best-made life plans.
So what does infertility entail? Well, it’s not always that straightforward and often seems a very daunting time. What we do know is that infertility is complex; cases may be caused by specific or multiple environmental, physical, physiological and biochemical factors, including cigarette smoke, alcohol, and abnormalities in homeostasis, hormonal imbalances, age and genetic alterations.3 There are also increasing numbers of diagnosed conditions that can affect female reproductive cycles including endometriosis and Polycystic Ovary Syndrome (PCOS).4 Male fertility is affected by a number of different factors that most commonly impact sperm quality, though tubule blockage, infection and prostate issues can also contribute to cases of male infertility.
Addressing infertility and preconception programmes can be a confusing time, coupled with the extra stress and emotions surrounding the situation. The extra pressure can also further exacerbate the situation, not least because excess stress hormones (cortisol and adrenaline) affect many areas of health, including hormone balance, potentially further impacting the problem.5
So what should be included in a preconception programmed to optimise fertility? Seeking medical advice may help to uncover a specific reason for infertility. There are also many qualified lifestyle medicine practitioners that are trained to tackle complex presentations with simple, yet effective evidence derived lifestyle medicine interventions.
A lifestyle preconception programme may address several aspects:
Certain environmental toxins are known to impact fertility. These include certain PCBs, organochlorine pesticides and phthalates found in common products like plastic bottles and food wrapping; paints, flame retardants in carpets, paints and furniture; toiletries, deodorants and make-up.6 These toxins are all classed as xeno-oestrogens7, which disrupt the endocrine hormone system responsible for female reproductive cycles, as well as sperm production and quality.8 Importantly, studies show that the biological effects of many toxicants are not linear; very low doses can have profound physiologic effects.9
Chemical sensitivity varies considerably, depending on age, biochemical individuality and synergistic effects from multiple toxicants.10 Minimising toxin exposure can be achieved through avoiding cigarette smoke and pollution; using cosmetics, household cleaning products and toiletries with only natural ingredients; eating more fresh foods and avoiding canned or wrapped products; emphasising organically grown foods, especially meat and dairy; and drinking filtered water. One study showed a significant reduction in BPA and DEHP (xenoestrogens) in urine samples when participants’ diets were restricted to food with limited packaging.11
Nutritional content of the diet, not just food source and packaging, also plays an important role in fertility, supporting the health and optimal function of both the male and female reproductive systems.12 Specific nutrients, such as phytonutrients found in green leafy vegetables, are also important for supporting the body’s detoxification systems13, which are involved in biotransformation and excretion of environmental toxins, as well as excess hormones like oestrogen that in excess can disrupt the delicate hormonal balance.14 A healthy gut and balance of gut bacteria is also important to support detoxification, hormone balance and absorption of nutrients from the diet. An imbalance of certain gut bacteria can lead to reabsorption of oestrogen destined for excretion via the gut, which in turn affects female hormone balance.15 A balanced diet and probiotics supplements can help maintain a healthy gut bacteria population.16
Specific nutritional inadequacies are also linked to conditions that may affect fertility such as Vitamin D deficiencies linked with endometriosis17 and the mineral zinc, found in foods like chickpeas and pumpkin seeds, which is important for male and female fertility and reproduction. Selenium is particularly important for male fertility and omega 3 essential fatty acids found in fish oils support healthy hormone balance. Government guidelines also suggest females trying to conceive should take 400μg folic acid daily to increase maternal folate status. Low maternal folate status is a risk factor in the development of neural tube defects in the developing fetus.18
So does this really work? Everybody’s case is different with their own unique set of biological factors impacting their fertility. However, one Harvard study concluded that women who followed a combination of five or more lifestyle factors, including changing specific aspects of their diets and increasing nutritional status, experienced more than 80% less relative risk of infertility due to ovulatory disorders compared to women who engaged in none of the factors.19
Seeking professional advice from a practitioner trained in lifestyle medicine, as well as other professionals trained to support people going through infertility, may help you to build a personalised programme and empower you on your journey. For more information about how nutrition can impact your health please see partner education courses at http://www.nutrihub.org.
3 Laxmidhar (2017) Epigenetics of reproductive infertility. Frontiers In Bioscience 9:509-535
4 Hester (2016) Is the prevalence of endometriosis on the rise? Contemporary Ob/Gyn http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/prevalence-endometriosis-rise
5 Dong (2017) Psychological stress is related to a decrease of serum anti-müllerian hormone level in infertile women. Repro Biol Endocrinol 15:51
7 https://en.wikipedia.org/wiki/Xenoestrogen 8 Zoeller RT et al. (2012). Endocrine-disrupting chemicals and public health protection: a statement of principles from the endocrine society. Endocrinology, 153(9): 4097–110 9 Kortenkamp A.. 2007. Ten years of mixing cocktails: a review of combination effects of endocrine-disrupting chemicals. Environ Health Perspect 115: suppl 198–105.
11 Rudel et al (2001) Food packing and BPA and DEHP phthalate exposure: Findings from a dietary intervention. Environ Health Perspect 119:914-920
12 Horman et al (2007) The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review . Human Reproduction Update 13:209–223
13 Hennig (2012) Nutrition can modulate the toxicity of environmental pollutants. EHP 120:771-774
14 Bulun (2012) Role of Estrogen Receptor-β in Endometriosis. Nat Med. 2012 Jul; 18(7): 1016–1018.
15 Kwa (2016) The Intestinal Microbiome and Estrogen Receptor–Positive Female Breast Cancer. J Natl Cancer Inst 108(8)
17 Holik et al (2006) High prevalence of Vitamin D inadequacy and implications for health. Mayo Clin Proc. 81:353
19 Zeinab (2015) Lifestyle and Outcomes of Assisted Reproductive Techniques: A Narrative Review. Global Journal of Health Science 7